Poster Session 09 Program Schedule
02/16/2024
03:30 pm - 04:45 pm
Room: Shubert Complex (Posters 1-60)
Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease
Final Abstract #9
Poster Symposium: Neuropsychological Care in Early Life Epilepsies: From Referrals to Outcomes — Abstract 2
Pre-Surgical Neuropsychological Evaluations with Young Children
Katrina Boyer, Boston Children's Hospital, Boston, United States
Song Dam, Boston Children's Hospital, Boston, United States
Clemete Vega, Boston Children's Hospital, Boston, United States
Category: Epilepsy/Seizures
Keyword 1: pediatric neuropsychology
Objective:
Epilepsy is a common pediatric condition with a peak of new onset in the first year of life. While the majority of children have good seizure control with anti-epileptic drugs (AED), approximately 30% have uncontrolled seizures despite appropriate medical treatment. For those with refractory seizures, epilepsy surgery is often considered for patients with focal epilepsy. Research has shown that proceeding to epilepsy surgery earlier in life can improve developmental outcomes as children with successful surgery can be afforded the opportunity to develop without the burden of seizures and AEDs. Over the past several years, a trend toward earlier epilepsy surgery has been observed and multiple research articles have been published regarding the safety of this treatment in children younger than 3 years of age. Neuropsychological evaluation is standard of care in the epilepsy surgery planning phase to document baseline function, assist in localization/lateralization of cerebral dysfunction, and identify developmental risks associated with surgical treatment. However, neuropsychological evaluation of children younger than school age is uncommon. Our aim is to make the case that adjusting neuropsychological practice to be inclusive of toddler and preschool age-children is feasible and essential in epilepsy surgery centers.
Results:
A shift toward more frequent epilepsy surgery for young children at our center necessitated neuropsychological assessment of patients in the preschool, toddler, and even infant stage. We have successfully expanded our service delivery to include younger patients. Use of tools in the infant and toddler range is important, along with highly focused behavioral observations and developmental interview. Added time for engagement with patients and families is important to maximize participation in assessment procedures. Flexible scheduling to accommodate nap times is necessary. As potential compromise of motor and language skills are often of particular concern in epilepsy surgery planning, these domains are important to assess in detail. Repeated evaluations over short duration during this period of rapid development may be essential in documenting developmental course as one factor in epilepsy surgery decision making.
Conclusions:
Neuropsychological evaluations of children age 3 years and younger presenting for epilepsy surgery is feasible and instrumental in supporting medical and surgical planning. As timing of epilepsy surgery trends younger to support developmental outcomes, it is important that the neuropsychological community respond to track developmental outcomes in these patients and establish an evidence base to support future epilepsy surgery decision-making.
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